The Ukrainian government’s efforts to combat Europe’s worst HIV/AIDS epidemic are being undermined by its failure to end persistent violence and discrimination against people at highest risk of infection, Human Rights Watch said in a report released this week.
The 84-page report, Rhetoric and risk: human rights abuses impeding Ukraine’s fight against HIV/AIDS (follow this link to download the full report, documents how draconian drug laws and routine police abuse of injection drug users – the population hardest hit by HIV/AIDS in Ukraine – keep them from receiving lifesaving HIV information and services that the government has pledged to provide.
“The HIV/AIDS policies that Ukraine has put in place are generally good ones,” said Rebecca Schleifer, researcher with Human Rights Watch’s HIV/AIDS program. “But until the government addresses the chronic abuses of people at highest risk of HIV/AIDS, it will have little hope of stemming its HIV epidemic.”
Ukraine’s national AIDS law, recognized as a model in the region, incorporates human rights protections for people living with HIV/AIDS. These include specific provisions that bar refusal of medical care based on HIV status, and guarantee access to appropriate medication, the right to HIV/AIDS information as well as confidentiality of HIV test results. Its national law and policy support syringe exchange and opiate-substitution therapy, which the World Health Organization and UNAIDS have endorsed as essential to strategies aimed at HIV prevention and care for drug users.
However, Human Rights Watch found that abusive practices, problematic regulations, and a failure to implement crucial provisions of national AIDS policies render these protections meaningless for most Ukrainians living with or at highest risk of HIV.
Police abuse, sometimes amounting to torture, keeps drug users away from basic HIV-prevention services like needle exchange, in direct contradiction to government policy in support of such services. Due to the criminalisation of even trace amounts of drugs for personal use, drug users are easy targets for police seeking to fulfill arrest quotas. Police also extort money and information from drug users, sometimes using the mere possession of syringes as an excuse to harass or arrest them or outreach workers providing services to them. Proposed changes in Ukraine’s drug laws to criminalise possession of smaller amounts of drugs than are currently prohibited threaten to exacerbate these abuses.
Discrimination by healthcare workers
Healthcare workers’ discriminatory practices toward people they know or suspect to be HIV-positive severely compromise the health of people living with HIV/AIDS. Human Rights Watch found that people working in healthcare frequently refuse to treat such people. They also routinely disclose confidential information about HIV status, exposing people living with HIV/AIDS to further discrimination and abuse. As a result, many people do not seek HIV testing out of fear that their status, if HIV-positive, could be revealed.
Substitution therapy reaches only a fraction of the drug users in need of it. According to the World Health Organization, at least 60,000 drug users need substitution therapy but, to date, only 200 treatment slots are available. This failure to ensure drug users’ access to the full range of HIV prevention and treatment services – including substitution therapy with methadone, which is legal in Ukraine – significantly undermines efforts to fight both AIDS and drug use.
Confidentiality of drug treatment
Drug treatment clinics are required to officially register drug users who are referred to them for treatment, and to share this information with law enforcement agencies. This practice keeps many drug users from seeking healthcare or drug treatment services, out of fear that their drug use will be reported to law enforcement.
Poor access to antiretrovirals
Antiretroviral drugs are available only to a small percentage of persons in need of such treatment. As many as 416,000 people – 1.7 per cent of Ukrainian adults – are living with HIV/AIDS in Ukraine. In 2004, with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the NGO International HIV/AIDS Alliance launched an antiretroviral program in Ukraine to treat people living with HIV/AIDS. Between April 2004 and December 2005, more than 2,600 people began antiretroviral treatment under this program. While this program has been said to be the most rapid treatment expansion in all of Eastern Europe, it still reaches only a small fraction of the 17,300 people in urgent need of treatment.
Furthermore, active injecting drug users are not considered capable of adhering to antiretroviral therapy and are excluded from treatment, the report shows. Several clinicians in the Ukraine told Human Rights Watch that injecting drug users should not receive treatment, while a doctor at a Kiev AIDS clinic said that few injecting drug users knew anything about antiretroviral therapy. Narcologists in Ukraine tended not to discuss antiretroviral therapy or even HIV status with their patients, Human Rights Watch found.
“Ukraine’s ambitious HIV/AIDS programs won’t succeed unless the government eliminates the abusive practices that undermine its prevention and treatment efforts,” said Schleifer. “Protecting human rights is essential if Ukraine hopes to expand access to antiretroviral treatment to the scale necessary.”
However, even if more positive policies were pursued in Ukraine, the lack of ongoing investment in services targeted at drug users is likely to hamper comprehensive efforts to contain the extensive epidemic among injecting drug users, according to Julie Banks of the International HIV/AIDS Alliance.
“The report refers to certain policies and practices in Ukraine which deter drug users from seeking healthcare or drug treatment services. However, the worrying reality is that many such services struggle to survive and suffer from a lack of financial and political investment and commitment – both at the national and international levels. This again relates to the highly-stigmatised nature of injecting drug use and the massive discrimination experienced by those who engage or are associated with it.”